RESUMEN
OBJECTIVE: Our aim was to examine underserved women's perceptions on mobile versus fixed mammography in Santa Clara, California through a focus group study. BACKGROUND: Research has shown that medically underserved women have higher breast cancer mortality rates correlated with under-screening and a disproportional rate of late-stage diagnosis. The Community Health Partnership in Santa Clara County, California runs the Community Mammography Access Project (CMAP) that targets nearly 20,000 medically underserved women over the age of 40 in the county through the collaborative effort of an existing safety net of healthcare providers. However, little data exists on the advantages or disadvantages of mobile mammography units from the patient perspective. METHODS: We assessed underserved women's perspectives on mammography services in Santa Clara County through two focus groups from women screened at mobile or fixed site programs. Patients were recruited from both CMAP clinics and a county hospital, and focus group data were analyzed using content analysis. RESULTS: We found that women from both the mobile and fixed sites shared similar motivating factors for getting a mammogram. Both groups recognized that screening was uncomfortable but necessary for good health and had positive feedback about their personal physicians. However, mobile participants, in particular, appreciated the atmosphere of mobile screening, reported shorter wait times, and remarked on the good communication from the clinic staff and empathetic treatment they received. However, mobile participants also expressed concern about the quality of films at mobile sites due to delayed initial reading of the films. CONCLUSIONS: Mobile mammography offers a unique opportunity for women of underserved populations to access high satisfaction screenings, and it encourages a model similar to CMAP in other underserved areas. However, emphasis should be placed on providing a warm and welcoming environment for patients and ensuring the quality of mammography images.
RESUMEN
Background: As more patient care moves into the outpatient arena, teaching medical residents in this setting has become of critical importance. Ambulatory teaching is especially challenging due to highly variable, unpredictable learning needs and little time for teaching. Recent literature suggests many strategies for effective teaching; however, most are not grounded in education theory. Summary: Using precepts of Adult Learning Theory, we review the literature on educational strategies for teaching medical residents in ambulatory settings. Many well known strategies apply the principle of learner involvement in setting educational goals; however, few strategies use principles such as explicit evaluation of task relevance or learner skill practice. Conclusions: We assert that Adult Learning Theory can be used to evaluate the expected effectiveness of suggested strategies for teaching medical residents in ambulatory settings. Furthermore, development and evaluation of new educational strategies should be grounded in sound theoretical models to enhance the likelihood of more effective teaching.